STUDENT WELFARE CONCUSSION MANAGEMENT

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1 STUDENT WELFARE CONCUSSION MANAGEMENT The Board of Education recognizes that concussions and head injuries are the most commonly reported injuries in children and adolescents who participate in sports and recreational activities. The physical and mental well-being of our students is a primary concerns. Therefore, the Plattsburgh City School District adopts the following Policy to support the proper evaluation and management of concussion injuries. The concussion is a traumatic brain injury (TBI). A concussion occurs when normal brain functioning is disrupted by a blow or jolt to the head or body that causes the head and brain to move rapidly back and forth. Recovery from concussion and its symptoms will vary. Avoiding re-injury and over-exertion until fully recovered are the cornerstones of proper concussion management. Concussions can impact a student s academic as well as their athletic pursuits. Concussion Management Team (CMT) In accordance with the Concussion Management and Awareness Act, the School District is authorized, at its discretion, to establish a Concussion Management Team (CMT) which may be composed of the certified athletic director, a school nurse, the school physician, a coach of an interscholastic team, a certified athletic trainer or such other appropriate personnel as designated by the School District. The Concussion Management Team shall oversee and implement the School District s concussion policy and regulations, including the requirement that all school coaches, physical education teachers, nurses and certified athletic trainers who work with and/or provide instruction to pupils engaged in school-sponsored athletic activities complete training relating to traumatic brain injuries. Furthermore, every concussion management team may establish and implement a program which provides information on traumatic brain injuries to parents and persons in parental relation throughout each school year. Staff Training/Course of Instruction Each school coach, physical education teacher, school nurse and certified athletic trainer who works with and/or provide instruction to students in school-sponsored athletic activities (including physical education class and recess) shall complete a course of instruction, consistent with New York State mandated guidelines, relating to recognizing the symptoms of concussions or TBIs and monitoring and seeking proper medical treatment for students who suffer from a concussion or TBI. Components of the training will include: a) The definition of TBI; b) Signs and symptoms of TBI;

2 -2- c) How TBIs may occur; d) Practices regarding prevention; and e) Guidelines for the return to school and school activities for a student who has suffered a TBI, even if the injury occurred outside of school. The course can be completed by means of instruction approved by SED which include, but are not limited to, courses provided online and by teleconference. Information to Parents The District shall include the following information on concussions in any permission or consent form or similar document that may be required from a parent/person in parental relation for the student s participation in interscholastic sports. Information will include: a) The definition of TBI; b) Signs and symptoms of TBI; c) How TBIs may occur; d) Practices regarding prevention, and e) Guidelines for the return to school and school activities for a student who has suffered a TBI, even if the injury occurred outside of school. The District will provide a link on its website to the above list of information on the State Education Department and Department of Health s websites. Identification of Concussion and Removal from Athletic Activities The District shall require the immediate removal from all athletic activities of any student who has sustained, or is believed to have sustained, a traumatic brain injury (TBI) or concussion. Any student demonstrating signs, symptoms or behaviors consistent with a concussion while participating in a class, extracurricular activity, or interscholastic athletic activity shall be removed from the class, game or activity and must be evaluated as soon as possible by an appropriate health care professional. Such removal must occur based on display of symptoms regardless of whether such injury occurred inside or outside of school. If there is any doubt as to whether the student has sustained a concussion, it shall be presumed that the student has been injured until proven otherwise.

3 -3- The District shall notify the student s parents or guardians and recommend appropriate evaluation and monitoring. The School District may choose to allow credentialed District staff to use validated Neurocognitive computerized testing as a concussion assessment tool to obtain baseline and post-concussion performance data. These tools are not a replacement for medical evaluation to diagnose and treat a concussion. Return to School Activities and Athletics The student shall not return to cognitive or physical activity (including athletics, physical education class, recess and classroom instruction) until he/she has been symptom-free for not less than twenty-four (24) hours, and has been evaluated and received written authorization from a licensed physician. In accordance with Commissioner s Regulations, the School District s Medical Director will give final clearance on a return to activity for extra-class athletics. All such authorizations shall be kept on file in the student s permanent health record. The standards for return to athletic activity will also apply to injuries that occur outside of school. School staff should be aware that students may exhibit concussion symptoms caused by injuries from outside activities and that these visible symptoms also indicate a removal from play. The District shall follow any directives issued by the student s treating physician with regard to limitations and restrictions on school and athletic activities for the student. The District s Medical Director may also formulate a standard protocol for treatment of students with concussions during the school day. In accordance with NYSED guidelines, the Policy shall be reviewed periodically and updated as necessary in accordance with New York State Education Department guidelines. The Superintendent, in consultation with the District s Medical Director and other appropriate staff, may develop regulations and protocols for strategies to prevent concussions, the identification of concussions, and procedures for removal from the return to activities or academics. Policy References: Education Law Section 207; 305(42), and NYCRR and Guidelines for Concussion Management in the School Setting, SED Guidance Document, June 2012

4 E.1 Plattsburgh City School District Concussion Management Plan In July of 2011 the Concussion Management and Awareness Act became law. The law took effect on July 1, 2012 and is now included in the Commissioner s Regulations section The details of the law are included in this document, the Concussion Management Plan. Additional information that will help educate and inform both students and parents on concussion management can be found at plattscsd.org under the Athletic and Concussion Management homepages. The law requires that a parent must sign off acknowledging that they have received information on concussion management. The Co-Curricular Code of Conduct and Parent Consent will serve as the consent form that must be reviewed, signed and returned to your child s coach. It will include information regarding concussion. You will receive this form from your child s coach during the pre-season. You may also request copies of these documents at the regularly scheduled Parent/Athlete Meetings held at the beginning of each season. This document, based on NYSED s Guidelines for Concussion Management in a School Setting, June 2012, will serve as the Plattsburgh City School District (PCSD) Concussion Management Plan. The plan will be kept on file in the Nurse s Office and Athletic Office. It will also be disseminated to students and parents via the coach at the beginning of each sports season and again if a student is suspected of a head injury. If you have any questions about the PCSD Concussion Management Plan, please direct them to the Director of Athletics. Information and Prevention Preventing a concussion: o Although the risk of a concussion may always be present with certain types of activities, in order to minimize the risk, the following actions will be taken: Educate students, parents and school staff on concussions and the PCSD Concussion Management Plan Education will include: o Definition of concussion and how concussions occur o Signs and symptoms of concussion o Post concussion and second impact syndrome o Return to play and school protocols o Available area resources for concussion management and treatment Teach proper skills Issue proper equipment Ensure that facilities are safe and regularly inspected Provide appropriate supervision Design lesson plans with student safety being a top priority Review and enforce rules of play Enforce rules of sportsmanship Instruct players on sport-specific safe body alignment and encourage them to be aware of what is going on around them Encourage proper strength and conditioning to help reduce head injuries Information available on the school website at plattscsd.org: o The Plattsburgh City School District Concussion Management Plan

5 E.1 o The Plattsburgh City School District Co-Curricular Code of Conduct, including Parent Consent o An informational pamphlet provided by the NYSPHSAA on concussions that is designed for parents and students (currently found online at o A link to this will lead to more concussion information that can be found on the NYSPHSAA website or via other links, such as the New York State Education Department and the Centers for Disease Control and Prevention. Pre-season required information: o By law, parent consent is required to compete in interscholastic athletics. The PCSD Co-Curricular Code of Conduct and Parent Consent will serve as the consent form. The coach must review the Concussion Management Plan with the players prior to the start of the regular season. NYSED s Guidelines for Concussion Management in the School Setting, can be found by visiting plattscsd.org, this document includes detailed information on guidelines that should be shared with the students and parents (pages 14 and 15). Information will also be discussed at each Parent Meeting scheduled at the beginning of each sport season. While district staff will exercise reasonable care to protect students, head injuries may still occur. STEPS FOLLOWING A HEAD INJURY: The following steps are required in the event a student may have sustained a concussion: o The COACH/PE TEACHER/TEACHER must immediately remove from play any student who has taken a significant blow to head or body, or presents with signs and symptoms of a head injury, in compliance with the Concussion Awareness Management Act. Symptoms of a concussion include, but are not necessarily limited to: Amnesia (e.g. decreased or absent memory of events prior to or immediately after the injury, or difficulty retaining new information) Confusion or appearing dazed Headache or head pressure Loss of consciousness Balance difficulty or dizziness, or clumsy movements Double or blurry vision Sensitivity to light and/or sound Nausea, vomiting, and/or loss of appetite Irritability, sadness or other changes in personality Feeling sluggish, foggy, groggy, or lightheaded Concentration or focusing problems Slowed reaction times, drowsiness Fatigue and/or sleep issues (e.g. sleeping more or less than usual) o Contact the school nurse and/or appropriate emergency medical services for assistance with any student injury.

6 E.1 o Send any student exhibiting signs and symptoms of a more significant concussion (see below) to the nearest hospital emergency room via emergency medical services. Headaches that are severe or worsen Seizures Looks drowsy and/or cannot be awakened Repeated vomiting Slurred speech Unable to recognize people or places Weakness or numbing in arms or legs, facial drooping Unsteady gait Dilated or pinpoint pupils, or change in pupil size of one eye Significant irritability Any loss of consciousness Suspicion of skull fracture: blood draining from ear, or clear fluid from nose o The COACH will inform the PARENT/GUARDIAN of the need for evaluation by their private medical provider. The COACH must refer the parent/guardian to the Plattsburgh City School District Concussion Management Plan webpage and provide a written Concussion Checklist Form that needs to be completed by the student s private medical provider. This will be the responsibility of the SCHOOL NURSE if the student was injured in PE class/recess. STUDENTS/PARENTS need to return all of the completed documents to the School Nurse s office. Parents should be advised to contact a private medical provider immediately following the student s injury. The medical provider should then determine if the student has a concussion. No student will be allowed to resume athletic activity (graduated return to play stepwise process listed below) until they have been symptom free for 24 hours, without pain-reducing medication, and have been evaluated by and received written and signed authorization from a LICENSED PHYSICIAN. o The COACH/PE TEACHER will inform the Athletic/PE Director and the school nurse of the student s potential concussion. This is necessary to ensure that the student does not engage in activities at school that may complicate the student s condition prior to having written clearance by a medical provider. In addition, the SCHOOL NURSE may be aware of other medical conditions affecting the student that may influence their recovery. IF a student sustains a concussion at a time other than when engaged in a school-sponsored activity, the district expects the parent/guardian to report the condition to the school nurse, so the district can support the appropriate management of the condition. Students who have been diagnosed with a concussion require both physical and cognitive rest. The SCHOOL NURSE will inform the PE teachers, classroom teachers, support staff, coach, the building principal, and Athletic Director, regarding all restrictions, accommodations, and signs to look for when working with a student that suffered a concussion. NYSED s Guidelines for Concussion Management in the School Setting includes detailed information on post-concussion management on pages Additional information on accommodations that can be used by the classroom teacher can be found on page 25 and 26 of NYSED s Guidelines for Concussion Management in the School Setting.

7 E.1 o The COACH/PE TEACHER will ensure that any student diagnosed with a concussion does not participate in any athletic activities until, in conjunction with the STUDENT S LICENSED PHYSICIAN, the PE teacher/coach has received written authorization from the School Nurse that the student has been cleared to participate by the SCHOOL MEDICAL DIRECTOR. o Once a student diagnosed with a concussion has been symptom free at rest without pain reducing medication, for at least 24 hours, a LICENSED PHYSICIAN may choose to clear the student to begin a graduated return to activities. If a district has concerns or questions about the physician s orders, the SCHOOL MEDICAL DIRECTOR should contact that provider to discuss and clarify. Additionally, the SCHOOL MEDICAL DIRECTOR has the final authority to clear students to participate in or return to extra-class physical activities in accordance with 8NYCRR 135.4(c)(7)(i). The SCHOOL NURSE will inform the parents if the School Medical Director does not approve a return to play. The SCHOOL MEDICAL DIRECTOR will consider all of the information (incident report, concussion checklist, school nurse or School Medical Director s evaluation) prior to clearing an athlete return to play. While the student recovers from a concussion, the COACH/PE TEACHER will not substitute cognitive/mental assignments for physical activities, unless the medical provider clears the student to do so. RETURN TO PLAY PROTOCOL Graduated stepwise return to play protocol o Students must be monitored by DISTRICT STAFF daily following each progressive challenge, physical or cognitive, for any return of signs and symptoms of concussion. STAFF MEMBERS need to report any observed return of signs and symptoms to the school nurse. A student can only move to the next level of activity if they remain symptom free at the current level. Return to activity occurs with the introduction of one new activity each 24 hours. If any post concussion symptoms return, the student must drop back to the previous level of activity, then re-attempt the new activity after another 24 hours have passed. A more gradual progression should be considered based on individual circumstances and a private medical provider s or other specialist s orders and recommendations. o If a symptom does return, the person who discovered or received information about the symptom must report this to the Athletic Director, School Nurse, and Coach. The SCHOOL NURSE will inform the parent regarding the return of a symptom. o A student cannot progress to the next step (Steps 2-5) without approval from the SCHOOL NURSE. If the school nurse is not available then the student will remain on their current phase. o The SCHOOL NURSE will oversee the graduated stepwise process. Step 1- No activity. Total rest until asymptomatic, without pain reducing medication. Step 2 - Light aerobic activity. Low impact, non-strenuous activity, such as walking, swimming or riding a stationary bike. No resistance training. Step 3- Sport specific non-contact activity. Running, skating. No head impact activities. Step 4- Sport specific activity, non-contact drills. Example: Passing drills in football and ice hockey. May start progressive resistance training Step 5- Full contact training drills and intense aerobic activity. Step 6- Return to full activities without restrictions.

8 E.1 PRIOR TO STEP 6 THE FOLLOWING MUST BE COMPLETED: o Once a student diagnosed with a concussion has successfully completed steps 1-5, THE SCHOOL NURSE will FAX Concussion Clearance Form to the SCHOOL MEDICAL DIRECTOR for his signed release in order for the student to begin full activities without restriction. The SCHOOL NURSE will inform the parents if the SCHOOL MEDICAL DIRECTOR does not approve a return to play. For elementary students, the SCHOOL NURSE will determine when the student meets criteria to resume full activity, in accordance with recommendations of the private health care provider. o After the SCHOOL MEDICAL DIRECTOR approves the student to return to full activities without restriction, the SCHOOL NURSE/HEALTH OFFICE will inform the PE teachers, classroom teachers, support staff, coach, and Athletic Director in writing that the student may fully participate in athletic activities. Additional Information: o It cannot be emphasized enough that any student suspected of having a concussion either based on the disclosure of a head injury, observed or reported symptoms, or by sustaining a significant blow to the head or body must be removed from athletic activity and/or physical activities (e.g. PE class, recess), and observed until an evaluation can be completed by a medical provider. For example, if a student comes to school with a symptom of a concussion as a result of a head injury that occurred at home, the student must be immediately removed from all athletic activities and the Concussion Management Plan must be enacted. o District staff members who observe a student displaying signs and/or symptoms of a concussion, or learn of a head injury from the student, should have the student accompanied to the school nurse. Information on concussions will be shared with teachers/staff at the start of each school year. o Any documentation related to a student s head injury must be kept on file in the student s permanent health record. o Students, whose symptoms worsen or generally show no reduction after 7-14 days, or sooner depending on symptom severity, should be referred back to their private health care provider. o Coaches, PE teachers, school nurse and athletic trainers are required to complete a NYSED approved concussion course consistent with New York State mandated guidelines. Approved courses can be accessed through the Statewide School Health Services Center website The Director of Physical Education and Athletics will keep evidence of completion of the required course on file in the Athletic Office, as is done with all other coaching certification requirements. o The PCSD will assemble a CONCUSSION MANAGEMENT TEAM (CMT) to oversee the implementation of the Concussion Management Plan. The Concussion Management Team will consist of the Director Athletics, the School Nurse, the School Medical Director, coach, PE teacher and such other appropriate personnel, as needed. There will be an ongoing review of the Concussion Management Plan. Revisions to the Concussion Management Plan will occur as needed.

9 E.2 Concussion in the Elementary Student In recognizing that concussions also occur in the elementary population, the district has created the following adaptation of the return-to-play protocol, for the purposes of concussion management and return to physical education, recess, and intramural sports. In-school injury Physical education teachers, nurses, coaches, and other appropriate staff will receive training regarding concussion consistent with the New York State mandated guideline. Students sustaining a blow or jolt to the head during school hours will be assessed for signs, symptoms, and behaviors associated with concussion by the school nurse. If a student sustains a head injury, the parent/guardian will be contacted immediately and directed to take the student for medical evaluation. In more emergent cases, 911 may be contacted as well. Out-of-school injury If a student sustains a concussion at a time other than when engaged in a school-sponsored activity, the district expects the parent/legal guardian to report the condition to the school nurse, so that the district can support the appropriate management of the condition. Concussion education Families are encouraged to learn more about concussion by visiting the district webpage Concussion Management tab. Management of concussion in the elementary student Return to play (physical education, recess, or intramural sports) following a concussion involves a stepwise progression once the individual is symptom free for 24 hours, without pain-reducing medication, and cleared by a licensed healthcare provider. There are many risks to premature

10 E.2 return to play including: a greater risk for a second concussion because of a lower concussion threshold, second impact syndrome (abnormal brain blood flow that can result in death), exacerbation of any current symptoms, and possibly increased risk for additional injury due to alternation in balance. No student should return to play while symptomatic. Students are prohibited from returning to play the day the concussion is sustained. If there is any doubt as to whether a student has sustained a concussion, it should be treated as a concussion. Once the student is symptom free at rest for 24 hours, without pain-reducing medication, and has a signed release by the treating clinician, she/he may begin the return to play progression below (provided there are no other mitigating circumstances). Graduated Steps to Return to Play The school nurse will set up an appointment with the student each school day. After evaluating the student each day throughout the graduated step process, the school nurse will inform (written or ) the P.E. teacher/coach if the student is allowed to progress to the next phase. The P.E. teacher/coach is to assume that the student did not progress to the next phase if he/she did not hear from the school nurse. Students must be monitored by district staff daily following each progressive challenge, physical or cognitive, for any return of signs and symptoms of concussion. Staff members need to report any observed changes to the school nurse. A student can only move to the next level of activity if they remain symptom free at the current level. Return to activity occurs with the introduction of one new activity each 24 hours. If any post- concussion symptoms return, the student must drop back to the previous level of activity, then re-attempt to new activity after another 24 hours have passed. A more gradual progression should be

11 E.2 considered based on individual circumstances and a private medical provider s or other specialists orders and recommendations. If a symptom does return, the person who discovered or received information about the symptom must report this to the school nurse. The school nurse will inform the parent regarding the return of a symptom. A student cannot progress to the next step (step 2-4) without written approval from the school nurse. If the school nurse is not available then the student will remain at their current step. Stepwise Progression Protocol for Elementary Students Step 1: Total rest until asymptomatic for 24 hours without pain-reducing medication. Step 2: Light aerobic activity, such as walking. Step 3: Moderate activity with higher impact/higher exertion, such as running or jumping rope. Step 4: Return to full activity